Professional Documents
Culture Documents
NEUROPATHY
MONICA MORENO MD
ENDOCRINOLOGY AND DIABETES CLINIC
IHC SAINT GEORGE UT
SALT LAKE CITY
NOVEMBER 2 2011
Objectives
2.Hypoglycemia unresponsiveness:
Reduction in glucagon and epinephrine
secretion in response to Hypoglycemia
GI
• Esophageal dysmotility
• Gastroparesis diabeticorum (25%)
• Diarrhea (20% nocturnal diarrhea/fecal
incontinence)
• Constipation (60%)
• Fecal incontinence
GU
• Anhidrosis
• Hyperhidrosis
• Heat intolerance
• Gustatory sweating
• Dry skin
Pupillary
1. Pupillomotor function impairment (e.g.,
decreased diameter of dark adapted
pupil)
2. Pseudo Argyll-Robertson pupil
DAN Screening
ADA Guidelines 2011
• Comprehensive HPI
• Microvascular complications:
– DPN
– DAN (ED,gastroparesis, incontinence,
recurrent infections, hypogycemia
unawareness)
DAN Screening
ADA Guidelines 2011
• Test HR variability
E:I ratio, valsalva maneuver, standing, EKG